What Is a Transforaminal Lumbar Interbody Fusion?

Posterior lumbar interbody fusion fusion, also known as posterior lumbar interbody fusion, is an orthopedic spinal fusion surgery.

Posterior lumbar interbody fusion

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Posterior lumbar interbody fusion fusion, also known as posterior lumbar interbody fusion, is an orthopedic spinal fusion surgery.

Chinese name

Posterior lumbar interbody fusion

Posterior lumbar interbody fusion

Posterior lumbar interbody fusion

Orthopaedics / Spine Surgery / Spine Fusion

81.0802

Posterior lumbar interbody fusion cage fusion is a spinal fusion technique with surgery-related anatomy.

Posterior lumbar interbody fusion cage fusion is suitable for:

1. Lumbar degenerative instability for various reasons, those with intervertebral disc herniation or spinal canal stenosis who need posterior decompression.

2. Postoperative lumbar spine instability requires posterior pedicle screw fixation.

3. Intervertebral disc-induced low back pain, anterior surgery is limited.

4. Lumbar spondylolisthesis for various reasons, who need to perform spinal decompression and reduction and fixation at the same time.

Tracheal intubation can be used for general anesthesia or continuous epidural anesthesia. The patient took the knee or chest position or lay on a special bow frame to make the spine lordosis to reduce epidural hemorrhage.

Take transforaminal lumbar intervertebral bone fusion (TLIF) as an example.

Incision

A straight midline incision is made along the spinous process with the lesion segment as the center, and the incision range includes one normal vertebral segment above and below the other.

2. Reveal the vertebral segment

The posterior median incision exposes the vertebral fusion to be fused, and hemi-lamina or total laminectomy is performed as appropriate, and the medial half of the unilateral or bilateral superior and inferior articular processes is decompressed. Pull the pony tail away, and confirm the upper and lower nerve roots.

3. Positioning

The distal-pointed guide rod with the handle-equipped posterior positioning guide was placed on both sides of the dural sac (outside of the sac), corresponding to the height of the intervertebral disc, and the center of the handle was at the midline. Cut the fiber ring at the tip of the guide rod with a sharp knife on both sides of the dural sac. The guide is pushed vertically to the lower intervertebral space, which is used as the implantation mark of the fusion device. Lateral X-ray perspective, the tip of the guide rod shows the depth that the drill can reach and its angle in the intervertebral space.

4. Open the intervertebral space

The small spreader is first screwed onto the introducer, and then the spreader is inserted into the 8mm hole of the vertebra. If the expansion bolt is loose, replace it with a larger model one after the other until the fiber loop is tightened. Determine the angle of the importer, and every subsequent step will follow this angle. Remove the handle, leave the spreader in place, and follow the same steps to complete the operation on the other side.

5. Place the drill sleeve

In the case that the other side has the function of spreading the bolt to spread the vertebra, the posterior drill sleeve with the indicator lip at the tail is inserted and fixed in the axillary part of the nerve root. At this point, you should be sure that the dural sac and nerve roots have been retracted under direct vision. Screw a fixing rod that is longer than the handle of the open bolt onto the sleeve guide to stabilize it. Pass the drill sleeve guide through the sleeve sheath, insert it into the 8mm hole, and insert the drill sleeve along the guide. The drill sleeve is located between the sheath and the guide. Make sure that the drill sleeve is at the correct angle from direct view and X-ray perspective (requires that it is parallel to the end plate and does not deviate from the center line). Gently knock the impact hammer down from the top of the drill sleeve until the surface of the sleeve guide comes into contact with the impact hammer, so that the sharp puncture under the sleeve penetrates into the bone of the vertebral body to make the trailing edge tightly engage. Then lower the impact hammer and take out the drill sleeve guide. Constantly press down the sleeve to prevent it from coming out.

6. Reaming and tapping

The guide rod of the same model as the spreading bolt is screwed into the starting grinding drill and maintained at the correct angle (can be judged by perspective). Insert the start-up grinding drill into the drill sleeve, and then drill the grinding drill deep into the depth of the sleeve to the predetermined depth scribe at the top of the sleeve, and then remove it. Clean the grinding drill and then continue to drill into the specified depth; if drilling is difficult, remove the grinding drill and remove the intervertebral disc with nucleus pulposus. At this point you still need to maintain the correct angle (perspective again). The shaped abrasive drill continues to drill into the depth until the depth controller is in contact with the tail above the drill sleeve. The depth of drilling can be checked again using X-ray fluoroscopy. The drill must reach the front 1/3 of the intervertebral space. Remove the sleeve to maintain the original position of the sheath, and remove all disc fragments with the nucleus pulposus through the sheath.

7. Place the fusion mold

First screw the fusion mold to the spreader introducer rod, then insert it from the sheath, and tap lightly to make it enter the drilled hole. Side X-ray examination to check the placement of the fusion mold. The correct position should be that the head is in the front 1/3 of the intervertebral space and then the fusion mold is removed.

8. Bone cracker

Under the premise of maintaining the correct angle, insert the bone hammer self-protection sleeve, push the bone hammer downward, and smooth the first few threads in the borehole. Stop once the preset scale is reached, otherwise all threads will be ground flat.

9. bone removal

Cancellous bone was cut out from the anterior epicondyle, and the autogenous bone fragments were inserted into the inner cavity of the BAK fusion device and inserted into it.

10. Implant BAK fusion device

The BAK fusion device is mounted on the mounting device, and the graduated surface of the fusion device faces the handle and the oval slot in the center of the fusion device, and the fixing bolt is screwed to the top of the fusion device to fix it. Insert the fusion device from the sheath and press it clockwise to rotate it. Once the scale mark reaches the top of the sheath, that is, when the T-handle is parallel to the intervertebral space, stop screwing in. Remove the BAK installer and drill sleeve sheath, and check the depth of implantation in parallel.

5. Close the incision

The layers are sutured in the usual order.

Vital signs and nervous system conditions were routinely monitored, and drainage tubes were removed within 24 hours after surgery. If the patient can tolerate it, encourage to get up.

Due to the trauma of implanting two intervertebral fusion cages in the posterior approach, it is necessary to remove half or more of the articular processes on both sides, affecting the stability of the spine, and increasing the chance of pulling the cauda equina and nerve roots. Zhao Jie et al. An intervertebral fusion with a single intervertebral cage implanted laterally and obliquely was used. On the one hand, the damage to the posterior structure is reduced, the stability is increased, at the same time, the drag on the cauda equina nerve and nerve root is reduced, and the treatment cost is reduced. This procedure is suitable for patients with lumbar spondylolisthesis with unilateral lower extremity neurological symptoms. A single fusion device can be implanted obliquely from one side during surgery. However, most patients need additional pedicle screw internal fixation.